Manipulator for grasping tissue

ABSTRACT

A manipulator adapted to grasp and draw tissue comprises first and second arms having proximal ends and distal ends separated by a distance. First and second grasping surfaces each connected to and extending from respective distal ends of the first and second arms are biased toward each other by a respective spring force. When the first and second arms are actuated to reduce the distance, the manipulator is configured such that tissue arranged between the first and second grasping surfaces resist actuation of the first and second arms. The first and second arms are further actuatable to overcome the spring force of the first and second grasping surfaces so that the first and second grasping surfaces pivot at respective pivot points such that the distance between the distal ends of the first and second arms is reduced.

CLAIM OF PRIORITY

This application is a continuation of U.S. patent application Ser. No.14/675,897, filed Apr. 1, 2015 entitled “MANIPULATOR FOR GRASPINGTISSUE” and which is a continuation of U.S. patent application Ser. No.13/449,190, filed Apr. 17, 2012 now U.S. Pat. No. 9,265,514 issued Feb.23, 2016 entitled “MANIPULATOR FOR GRASPING TISSUE” which applicationsare incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

This invention relates generally to manipulators used for grasping andholding objects and tissue.

BACKGROUND OF THE INVENTION

Several methods are known for surgically grasping tissue usingmanipulators. Stability of grasping is commonly increased by rougheningand toothing in several patterns to thereby increase the adhesion ofcontact surfaces of the manipulator. Depth of grasping is commonlyincreased by taking on a thread, using multiple manipulators applied inseveral steps, or stitching with a curved needle and tying to seal veinslying in deeper layers.

As technology has developed, there has been an increase in the need formanipulators which are capable of being used in tighter spaces and whichare capable of being used in more difficult medical procedures. Theapplication of manipulators in narrow spaces, such as in body cavitiesor through body orifices, is usually complicated and often requires theuse of multiple manipulators applied in several steps, which increasesthe duration and complexity of a medical procedure, and thus thelikelihood of complications.

There is a need to develop a manipulator that reduces the imperfectionsof known solutions, which is preferably easy and quick to apply, whichis suitable for pulling in and grasping tissues with large surface andmass, and which is suitable for manipulation in deeper layers.

SUMMARY

In accordance with an embodiment of the invention, a manipulator adaptedto grasp tissue comprises a first arm, a first grasping surfaceconnected to and extending from the first arm, a second arm, and asecond grasping surface connected to and extending from the second arm.The first arm and the second arm are separated by a distance. The firstgrasping surface and the second grasping surface extend toward eachother, and are each arranged at an initial position relative to therespective arm from which they extend by a spring force. When the firstarm and second arm are actuated to reduce the distance between them, thefirst grasping surface and the second grasping surface are contactablesuch that the first grasping surface and the second grasping surfaceresist actuation of the first arm and the second arm. The first arm andsecond arm can be further actuated such that a counter force is appliedto the first grasping surface and the second grasping surface. When thecounter force overcomes the spring force of the first grasping surfaceand the second grasping surface, the first grasping surface and thesecond grasping surface pivot at respective pivot points so that thedistance between the distal ends of the first and second arms isreduced.

In some embodiments of the invention, the spring force is applied to thefirst and second grasping surfaces by one of a leaf spring, a torsionspring, a hydraulic device, a pneumatic device, and a magnetic device.In some embodiments of the invention, the first and second graspingsurfaces are leaf springs having a parabolic shape and the first andsecond pivot points are fixed points at which the first and secondgrasping surfaces are bendable. In some embodiments of the invention,the first and second grasping surfaces are circular in cross-section andare connected to the respective pivot points off-center.

In some embodiments of the invention, the first arm and the second armare hingedly connected at respective proximal ends, and can optionallybe manually actuatable by a user. In other embodiments, the first armand the second arm are remotely actuatable.

In some embodiments of the invention, the manipulator further comprisesa first rigid grasper connected with the first arm and a second rigidgrasper connected with the second arm. When the first grasping surfaceand the second grasping surface reach a maximum actuation, the tissuedrawn toward the manipulator is firmly held between the first rigidgrasper and the second rigid grasper.

In some embodiments of the invention, the manipulator further comprisesa therapeutic or diagnostic device having a first portion connected withthe first arm and a second portion connected with the second arm. Whenthe first grasping surface and the second grasping surface reach athreshold, the therapeutic or diagnostic device can be operated. In someembodiments, the therapeutic or diagnostic device is a vein sealer. Whenthe first grasping surface and the second grasping surface reach athreshold actuation, the first vein sealer portion and the second veinsealer portion can be operated to seal a vein held therebetween. In someembodiments of the invention, the first and second vein sealer portionsare a bipolar electrode pair. In some embodiments of the invention, thefirst and second vein sealer portions are a clip applying pair offorceps.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective view of an embodiment of a manipulator inaccordance with the present invention including grasping surfaces fordrawing tissue toward the manipulator.

FIG. 1B is a detail view of the grasping surfaces of the manipulator ofFIG. 1A.

FIGS. 1C-1H are a sequence of detailed views of the grasping surfaces ofthe manipulator of FIGS. 1A and 1B being actuated and released.

FIG. 1I is an exploded view of the manipulator of FIGS. 1A-1H.

FIG. 2A is a perspective view of an alternative embodiment of amanipulator in accordance with the present invention comprisingdisposable heads each including a distal portion of an arm and agrasping surface.

FIG. 2B is a detail view of the grasping surfaces of the manipulator ofFIG. 2A.

FIGS. 3 and 4 are partial perspective views of attachment mechanisms forattaching grasping surfaces to manipulator arms.

FIG. 5A is a perspective view of an alternative embodiment of amanipulator in accordance with the present invention.

FIG. 5B is a detail view of grasping surfaces of the manipulator of FIG.5A.

FIG. 6 is a detail view of grasping surfaces of an alternativemanipulator.

FIG. 7A is a partial exploded view and FIG. 7B is a top detail view ofgrasping surfaces of an alternative manipulator.

FIGS. 8A and 8B are partial top views of an alternative embodiment of amanipulator in accordance with the present invention in an open andclosed configuration, respectively.

FIGS. 8C and 8D are side views of the manipulator of FIGS. 8A and 8B inan open and closed configuration, respectively.

FIG. 9A is a perspective view of an alternative embodiment of amanipulator in accordance with the present invention.

FIG. 9B is a detail view of the grasping surfaces of the manipulator ofFIG. 9A.

FIG. 10A is a partial exploded view of an alternative embodiment of amanipulator in accordance with the present invention.

FIG. 10B is a top view of the grasping surfaces of the manipulator ofFIG. 10A.

FIGS. 11A and 11B are partial end views of a further embodiment of amanipulator in accordance with the present invention in an open andclosed configuration, respectively.

FIGS. 11C and 11D are side views of the manipulator of FIGS. 11A and 11Bin an open and closed configuration, respectively.

FIG. 12 is a top view of a manipulator comprising the arms and graspingsurfaces of FIGS. 11A-11D in an open configuration.

FIG. 13 is a side view of an endoscope for use with embodiments ofmanipulators in accordance with the present invention.

FIGS. 14A and 14B are partial top view of a still further embodiment ofa manipulator in accordance with the present invention engaging tissueand isolating a vein.

FIG. 15 is a schematic view of the grasping surface for use withembodiments of manipulators in accordance with the present invention.

FIGS. 16, 17, and 18 are detailed views of varying grasping surfacesusable with embodiments of manipulators in accordance with the presentinvention.

FIGS. 19A and 19B are partial top views of an alternative embodiment ofa manipulator in accordance with the present invention in an open andclosed configuration, respectively.

FIG. 19C is a partial side view of the manipulator of FIGS. 19A and 19B.

FIGS. 20A and 20B are partial top views of an alternative embodiment ofa manipulator in accordance with the present invention in a closed andopen configuration, respectively.

FIGS. 21A-21E illustrate advancement of a grasping surface for use withembodiments of manipulators in accordance with the present invention asthe manipulator arms are closed.

FIGS. 22A and 22B are partial top views of an embodiment of amanipulator in accordance with the present invention for advancing athread along an axis.

FIGS. 23A and 23B are partial end views of an embodiment of amanipulator in accordance with the present invention for advancing athread along an axis.

FIG. 23C is a partial side view of the manipulator of FIGS. 23A and 23B.

FIG. 23D is a partial top view of the manipulator of FIGS. 23A-23C.

FIGS. 24A-24D illustrate incremental advancement of a target usingembodiments of grasping surfaces for use with manipulators in accordancewith the present invention.

FIGS. 25A-25E illustrate an alternative embodiment of a grasping surfacefor use with embodiments of manipulators in accordance with the presentinvention and incremental advancement of the grasping surface adjust thesize of a tube.

FIGS. 26A-26D illustrate a further embodiment of a grasping surface foruse with embodiments of manipulators in accordance with the presentinvention and incremental advancement of the grasping surface within atube.

FIGS. 27A and 27B are partial top views of an embodiment of amanipulator in accordance with the present invention in an open andclosed configuration, respectively.

FIGS. 28A-28E illustrate an alternative embodiment of a grasping surfacefor use as a locomotive device in accordance with the present invention.

FIGS. 29A-29C illustrate an embodiment of an advanceable endoscope inaccordance with the present invention.

FIGS. 30A and 30B illustrate an alternative embodiment of a graspingsurface in accordance with the present invention in an open and closedconfiguration.

DETAILED DESCRIPTION

The following description is of the best modes presently contemplatedfor practicing various embodiments of the present invention. Thedescription is not to be taken in a limiting sense but is made merelyfor the purpose of describing the general principles of the invention.The scope of the invention should be ascertained with reference to theclaims. In the description of the invention that follows, like numeralsor reference designators will be used to refer to like parts or elementsthroughout. In addition, the first digit of a reference numberidentifies the drawing in which the reference number first appears.

FIGS. 1A-1I illustrate an embodiment of a manipulator 100 in accordancewith the present invention adapted for grasping and pulling tissues. Themanipulator 100 comprises a pair of arms 102 a, 102 b each of which isconnected with a grasping surface 104 a, 104 b at a pivot point 106 a,106 b. The grasping surfaces 104 a, 104 b are leaf springs that resemblefingers having a semi-parabolic shape that curve outward with a convexorientation relative to respective arms 102 a, 102 b. The pivot points106 a, 106 b are fixed points at which the grasping surfaces 104 a, 104b are fixed and about which the grasping surfaces 104 a, 104 b bend. Asshown, the arms 102 a, 102 b of the manipulator 100 resemble a pair offorceps. Levers 152 a, 152 b connected at a hinge 156 actuate the arms102 a, 102 b when urged together. Proximal ends of the levers 152 a, 152b includes finger loops 150 a, 150 b, and a locking mechanism 154 a, 154b to allow the manipulator 100 to act as a clamp to fix tissue in place.The manipulator can be useful, for example, in combination withendoscopes, enabling a large quantity of tissue on a large surface to beprecisely grasped. All of the embodiments of manipulators describedherein can be hand actuated, for example as a pair of forceps, oralternatively arms of a manipulator can extend from a non-hand actuatedtool such as a robotic device controlled by a physician or controlled byan automated system.

In FIG. 1A and 1B, the manipulator 100 is open, in that the graspingsurfaces 104 a, 104 b are arranged to contact tissue for grasping. Oncethe grasping surfaces 104 a, 104 b are contacted to the target tissue,the manipulator 100 can be actuated to draw tissue into the manipulator100 (i.e., toward the user holding the manipulator). The spring force ofthe grasping surfaces 104 a, 104 b and optional roughing and/or toothingof the grasping surfaces 104 a, 104 b resist slippage of the tissue heldtherebetween. Referring to FIGS. 1C-1H, the arrangement of the graspingsurfaces 104 a, 104 b relative to each other is shown at stages I-IV ofactuation of the manipulator 100 and at stages V-VI of release of themanipulator 100. As can be seen, the grasping surfaces 104 a, 104 b areoffset from the arms 102 a, 102 b of the manipulator by the pivot points106 a, 106 b which extend laterally away from the arms 102 a, 102 b.That is, the grasping surfaces 104 a, 104 b are offset from a planedefined by the arms 102 a, 102 b. This offset allows the graspingsurfaces 104 a, 104 b to avoid physical interference with the arms 102a, 102 b as the arms 102 a, 102 b are actuated toward each other. Thiscan be seen most clearly in FIG. 1F, where the distal ends of thegrasping surfaces 104 a, 104 b overlap the arms 102 a, 102 b. As can beseen, the grasping surfaces 104 a, 104 b contact each other, and thegrasping surfaces 104 a, 104 b urge each other away from the distal endsof the arms 102 a, 102 b (i.e., the pivot points 106 a, 106 b) towardthe proximal ends of the arms 102 a, 102 b. Where tissue is arrangedbetween the contact points, the tissue is drawn into the manipulator100. This can be seen, for example, in FIGS. 14A and 14B describedbelow. As shown in FIG IF, as actuation proceeds, the grasping surfaces104 a, 104 b bend at the pivot points 106 a, 106 b until relatively flatportions of the grasping surfaces 104 a, 104 b contact each other. Wheretissue is arranged between the grasping surfaces 104 a, 104 b, therelatively flat portions provide increased surface area, including anyroughened and/or toothed surface area, for securing the tissue andpreventing slippage when the locking mechanism 154 a, 154 b of themanipulator 100 is engaged to fix the tissue in place. As can be seen inFIGS. 1G and 1H, as the manipulator 100 is released, the spring force ofthe grasping surfaces 104 a, 104 b urge the grasping surfaces 104 a, 104b (and consequently the arms 102 a, 102 b) apart to their originalposition.

FIG. 11 is an exploded view of the manipulator 100 of FIGS. 1A-1H. Insome embodiments, manipulators in accordance with the present inventioncan be made from a sterilizable, durable material, such as surgicalgrade stainless steel or polyether ether ketone (PEEK). In otherembodiments, for example where a disposable instrument is desired foruse, manipulators in accordance with the present invention can be madeof a thermopolymer or combination of polymers. In other embodiments,manipulators in accordance with the present invention can be made of acombination of materials. For example, manipulators in accordance withthe present invention can comprise levers and arms made from a metal,such as surgical grade stainless steel connected with a head includingthe grasping surfaces made of a polymer. One of ordinary skill in theart, upon reflecting on the teachings herein and the materials used insurgical and medical procedures, will appreciate the myriad differentmaterials with which manipulators in accordance with the presentinvention can be formed.

FIGS. 2A and 2B illustrate an alternative embodiment of a manipulator200 in accordance with the present invention adapted for grasping andpulling tissues. The manipulator 200 comprises a pair of arms 202 a, 202b each of which is connected with a removable head 201 a, 201 b. Theremovable head 201 a, 201 b includes a grasping surface 204 a, 204 bconnected with the head 201 a, 201 b at a pivot point 206 a, 206 b. Thegrasping surfaces 204 a, 204 b are rigid or semi-rigid surfacesextending about one-half to three-quarters of the circumference of aring and connected with a pivot point 206 a, 206 b near one end,although in other embodiments the grasping surfaces can have a differentshape. A leaf spring 203 a, 203 b is nested within the inner surface ofeach of the grasping surfaces 204 a, 204 b applying a bias spring forceto resist the grasping surfaces 204 a, 204 b pivoting toward each other.The pivot points 206 a, 206 b include shafts that allow the graspingsurfaces 204 a, 204 b to pivot relative to the head 201 a, 201 b (asopposed to merely allowing bending as in the previous embodiment). Asabove, the manipulator 200 further comprises levers 252 a, 252 bconnected at a hinge 256 actuate the arms 202 a, 202 b when urgedtogether. Proximal ends of the levers 252 a, 252 b includes finger loops250 a, 250 b, and a locking mechanism 254 a, 254 b to allow themanipulator 200 to act as a clamp to fix tissue in place.

Once the grasping surfaces 204 a, 204 b are contacted to the targettissue, the manipulator 200 can be actuated to draw tissue into themanipulator 200 (i.e., toward the user holding the manipulator). As canbe seen in FIG. 2B, the grasping surfaces 204 a, 204 b are offset fromthe arms 202 a, 202 b of the manipulator 200. That is, the graspingsurfaces 204 a, 204 b are offset from a plane defined by the arms 202 a,202 b to allow the grasping surfaces 204 a, 204 b to avoid physicalinterference with the arms 202 a, 202 b as the arms 202 a, 202 b areactuated toward each other. As the arms 202 a, 202 b are actuated, thegrasping surfaces 204 a, 204 b approach each other and captured tissuearranged therebetween urge the grasping surfaces 204 a, 204 b to rotateinwardly so that the hinge points 206 a, 206 b can come together. Thetissue arranged between the grasping surfaces 204 a, 204 b is drawn intothe manipulator 200. When the manipulator 200 is released, the springforce of the leaf springs 203 a, 203 b urge the grasping surfaces 204 a,204 b to rotate in opposite directions, pushing the arms 202 a, 202 bapart to their original position.

As mentioned, the embodiment of FIG. 2A and 2B include detachable heads201 a, 201 b. Use of a detachable heads can allow the manipulator 200 tobe fit with appropriately sized heads based on the procedure performed,with heads including additional therapeutic and/or diagnostic tools suchas vein sealers. Use of detachable heads can also allow recently usedheads to be replaced with recently sterilized heads. The detachableheads can be made from metal, such as surgical grade stainless steel, orthe detachable heads can be formed of a thermopolymer for reduced costand disposability, for example. The manipulator can also besemi-disposable, with a levers and arms being made from surgical gradestainless steel and detachable heads being made of a thermopolymer, forexample. FIGS. 3 and 4 illustrate two different mechanisms forconnecting a detachable head with the arms of a manipulator. FIG. 3includes a spring biased sphere 305 b extending from an attachment pointof an arm 302 b that pops into a complementary feature (not shown) inthe inner surface of the head 304 b. FIG. 4 includes a pair of tines 405b extending from the head 404 b that are inserted into a hollow cavityof the arm 402 b until the head 404 b and tines 405 b latch intocomplementary features of the arm 402 b.

FIGS. 5A and 5B illustrate an alternative embodiment of a manipulator500 in accordance with the present invention adapted for grasping andpulling tissues. The manipulator 500 comprises a pair of arms 502 a, 502b each of which is connected with a grasping surface 504 a, 504 b at apivot point 506 a, 506 b. The grasping surfaces 504 a, 504 b are rigidor semi-rigid surfaces which are cylindrically shaped and connected tothe pivot points 506 a, 506 b off-center, near an edge of the graspingsurfaces 504 a, 504 b. In other embodiments, the grasping surfaces neednot be circular in cross-section. For example, the grasping surfaces canbe elliptical in cross-section. Helical torsion springs 503 a, 503 b arearranged between respective arms 502 a, 502 b and grasping surfaces 504a, 504 b to apply a bias spring force to resist the grasping surfaces504 a, 504 b pivoting toward each other. The pivot points 506 a, 506 binclude shafts that allow the grasping surfaces 504 a, 504 b to pivotrelative to the arms 502 a, 502 b. As above, the manipulator 500 furthercomprises levers 552 a, 552 b connected at a hinge 556 actuate the arms502 a, 502 b when urged together. Proximal ends of the levers 552 a, 552b includes finger loops 550 a, 550 b, and a locking mechanism 554 a, 554b to allow the manipulator 500 to act as a clamp to fix tissue in place.

Once the grasping surfaces 504 a, 504 b are contacted to the targettissue, the manipulator 500 can be actuated to draw tissue into themanipulator 500 (i.e., toward the user holding the manipulator). As canbe seen in FIG. 5B, the grasping surfaces 504 a, 504 b are offset fromthe arms 502 a, 502 b of the manipulator 500. That is, the graspingsurfaces 504 a, 504 b are offset from a plane defined by the arms 502 a,502 b to allow the grasping surfaces 504 a, 504 b to avoid physicalinterference with the arms 502 a, 502 b as the arms 502 a, 502 b areactuated toward each other. As the arms 502 a, 502 b are actuated, thegrasping surfaces 504 a, 504 b approach each other and captured tissuearranged therebetween urge the grasping surfaces 204 a, 204 b to rotateinwardly so that the hinge points 506 a, 506 b can come together. Thetissue arranged between the grasping surfaces 504 a, 504 b is drawn intothe manipulator 500. The grasping surfaces 504 a, 504 b are texturedalong their edges to resist slippage of tissue held therebetween. Thetexture shown includes a series of diagonal grooves. However, myriaddifferent texture patterns and features such as roughening, toothing,and grooving can be used with any of the embodiments of manipulatorsdescribed herein, some patterns of which are described below. When themanipulator 500 is released, the spring force of the helical torsionsprings 503 a, 503 b urge the grasping surfaces 504 a, 504 b to rotatein opposite directions, pushing the arms 502 a, 502 b apart to theiroriginal position.

FIG. 6 illustrates an alternative embodiment of a manipulator 600 inaccordance with the present invention adapted for grasping and pullingtissues. The manipulator 600 resembles the manipulator 500 of FIGS. 5Aand 5B. However, grasping surfaces 604 a, 604 b of the manipulator 600connected with arms 602 a, 602 b each include pegs 640 a, 640 b and arespring biased by leaf springs 603 a, 603 b connected between respectivepegs 604 a, 604 b and arms 602 a, 602 b. The grasping surfaces 604 a,604 b are textured along their edges to resist slippage of tissue heldtherebetween. However, the texture differs from previous embodiments,and is shown to illustrate one of multiple different textures usablewith the grasping surfaces 604 a, 604 b.

FIGS. 7A and 7B illustrate an alternative embodiment of a manipulator700 in accordance with the present invention adapted for grasping andpulling tissues. The manipulator 700 resembles the manipulators 500, 600of FIGS. 5 and 6. However, grasping surfaces 704 a, 704 b of themanipulator 700 are spring biased with a leaf spring 703 arranged in acavity around the pivot point 706 at the end of respective arms 702 a,702 b. The cavity has a stop 748 a, 748 b that contacts a key 740 a, 740b which is biased by a spring 703 a, 703 b held within the cavity.Rotation of the grasping surfaces 704 a, 704 b is restricted in onedirection by the stops 748 a, 748 b, and is resisted in the oppositedirection by the springs 703 a, 703 b. As shown, the pivot points 706are connected and are free rotate relative to respective arms 702 a, 702b by a pin 746. The pivot points 706 are received within respectivecavities of the grasping surfaces 704 a, 704 b. The cavities are sealedby caps 742 a, 742 b which are fixed in position by screws 744 a, 744 bor other fixation device. Note that the peg 746 and pivot point 706 areshown for only the right head, but the features are intended to beidentical for the left head in this embodiment. Sealing the spring biasmechanism can, for example, reduce the amount of exposed moving parts ofthe manipulator thereby potentially increasing safety and preventadditional points of contamination accumulation during procedures

FIGS. 8A and 8B illustrate an alternative embodiment of a manipulator800 in accordance with the present invention. The manipulator 800comprises a pair of arms 802 a, 802 b each of which is connected with agrasping surface 804 a, 804 b at a pivot point 806 a, 806 b. Each of thegrasping surfaces 804 a, 804 b has a semi-circular shape that curvesinward relative to the other grasping surface 804 a, 804 b. The graspingsurfaces 804 a, 804 b are spring biased, and can be spring biased usingany of the spring features described in embodiments described herein, orany other spring features that may be contemplated by one of ordinaryskill in the art upon reflecting on the teachings presented herein. Themanipulator 800 further comprises rigid grasping sections 808 a, 808 beach extending from a portion of a corresponding arm 802 a, 802 b. Themanipulator can be useful, for example, in combination with endoscopes,enabling a strong, but rougher grasping of a large quantity of tissue.

In FIG. 8A, the manipulator 800 is open, in that the grasping surfaces804 a, 804 b are arranged to contact tissue for grasping. Once thegrasping surfaces 804 a, 804 b are contacted to the target tissue, theyare actuated by moving the arms 802 a, 802 b toward each other andurging the manipulator 800 toward the target tissue. As the arms 802 a,802 b are moved closer together, the grasping surfaces 804 a, 804 brotate at their pivot points 806 a, 806 b, grasping tissue and pullingtissue into the gap between the arms 802 a, 802 b. As the arms cometogether, the tissue is further contacted and captured by the rigidgrasping sections 808 a, 808 b, which offer increased surface area forcontacting the tissue, and which rigidly hold captured tissue in place.FIGS. 8C and 8D are side views of the manipulator 800 in an open andclosed configuration, respectively. An offset can be seen between thegrasping surfaces 804 a, 804 b and the grasping sections 808 a, 808 bthat avoids physical interference between the grasping surfaces 804 a,804 b and the grasping sections 808 a, 808 b when the manipulator 800 isactuated. Referring again to FIG. 8A, the arms 802 a, 802 b of themanipulator 800 are mechanically bendable about two pivot points. Thearms 802 a, 802 b can be bent perpendicular to an axis of the arms 802a, 802 b at a first pivot point 810 a, 810 b, i.e. into or out of thepage from top to bottom. The arms 802 a, 802 b can also be bent aboutthe axis of the arms 802 a, 802 b at a second pivot point 812 a, 812 b,i.e. into or out of the page from left to right. By mechanically bendingthe arms 802 a, 802 b, the grasping surfaces 804 a, 804 b can bearranged at a desired angle, including acute and obtuse angles.

FIGS. 9A and 9B illustrate an alternative embodiment of a manipulator900 in accordance with the present invention adapted for grasping andpulling tissues. The manipulator 900 comprises a pair of arms 902 a, 902b each of which is connected with a grasping surface 904 a, 904 b at apivot point 906 a, 906 b. The distal portions of the arms 902 a, 902 bare angled at 90° from the proximal ends of the arms 902 a, 902 b andthe levers 952 a, 952 b so that a user can access target tissue locatedat an angle relative to an incision, for example. In other embodiments,the distal portions of the arms can extend at a different angle relativeto the proximal ends of the arms and/or the levers. The graspingsurfaces 904 a, 904 b are rigid or semi-rigid surfaces which have afrustum shape. The frustum shape is intended to allow the edges of thegrasping surfaces to mate along their surface, and accounts for therelative angle introduced by the geometry of the hinged arms 902 a, 902b. For manipulators that are not actuated at a hinge, but rather includearms arranged parallel to each other during actuation the graspingsurface can be cylindrical.

The grasping surfaces 904 a, 904 b each include pegs 940 a, 940 b andare spring biased by leaf springs 903 a, 903 b connected betweenrespective pegs 904 a, 904 b and arms 902 a, 902 b. The springs 903 a,903 b resist the grasping surfaces 904 a, 904 b, and by extension thepivot points 906 a, 906 b from being urged together. The pivot points906 a, 906 b include shafts that allow the grasping surfaces 904 a, 904b to pivot relative to the arms 902 a, 902 b. As above, the manipulator900 further comprises levers 952 a, 952 b connected at a hinge 956actuate the arms 902 a, 902 b when urged together. Proximal ends of thelevers 952 a, 952 b includes finger loops 950 a, 950 b, and a lockingmechanism 954 a, 954 b to allow the manipulator 900 to act as a clamp tofix tissue in place. Once the grasping surfaces 904 a, 904 b arecontacted to the target tissue, the manipulator 900 can be actuated todraw tissue away from the target location. As with previous embodiments,when the manipulator 900 is released, the spring force of the springs903 a, 903 b urge the grasping surfaces 904 a, 904 b to rotate inopposite directions, pushing the arms 902 a, 902 b apart to theiroriginal position.

FIGS. 10A and 10B illustrate an alternative embodiment of a manipulator1000 in accordance with the present invention adapted for grasping andpulling tissues. The manipulator 1000 resembles the manipulator 900 ofFIGS. 9A and 9B. However, leaf springs 1003 a, 1003 b connected betweentwo pings 1040 a, 1040 b and a bracket-and-screw 1042 a, 1042 barrangement of the arms 1002 a, 1002 b. Upon reflecting on the teachingherein and the differences between the two embodiments, one of ordinaryskill in the art will appreciate other mechanisms for exerting a springforce on the grasping surfaces 1004 a, 1004 b, all of which arecontemplated and intended to be within the scope of the presentinvention. Further, as shown in FIG. 10B, the grasping surfaces 1004 a,1004 b are rounded in shape along the edges to account for an angleintroduced by the compound arms 1002 a, 1002 b. It can be useful whenthe distal portions of the arms 1002 a, 1002 b are angled at variabledegrees relative to the proximal ends of the arms 1002 a, 1002 b and thelevers, the rounded shape can allow the edges of the grasping surfaces1004 a, 1004 b to mate along their surface. In some embodiments, thegrasping ticket can be made from a more flexible material to allow theedges to at least partially flatten out against grasped tissue toincrease surface contact.

FIGS. 11A-11D illustrate an alternative embodiment of a manipulator 1100in accordance with the present invention. The manipulator 1100 comprisesa pair of arms 1102 a, 1102 b each of which is connected with a graspingsurface 1104 a, 1104 b at a pivot point 1106 a, 1106 b. Each of thegrasping surfaces 1104 a, 1104 b has a semi-circular shape that curvesinward relative to the other grasping surface 1104 a, 1104 b. Thegrasping surfaces 1104 a, 1104 b are spring biased, and can be springbiased using any of the spring features described in embodimentsdescribed herein, or any other spring features that may be contemplatedby one of ordinary skill in the art upon reflecting on the teachingspresented herein. The manipulator 1100 also includes a vein sealer 1108a, 1108 b associated with the arms 1102 a, 1102 b.

In FIG. 11A, the manipulator 1100 is open, in that the grasping surfaces1104 a, 1104 b are arranged to contact tissue for grasping. Once thegrasping surfaces 1104 a, 1104 b are contacted to the target tissue,they are actuated by moving the arms 1102 a, 1102 b toward each otherand urging the manipulator 1100 toward the target tissue. As the arms1102 a, 1102 b are moved closer together, the grasping surfaces 1104 a,1104 b rotate at their pivot points 1106 a, 1106 b, grasping tissue andpulling tissue into the gap between the arms 1102 a, 1102 b. As the arms1102 a, 1102 b come together, the vein sealer 1108 a, 1108 b can beactivated to seal a vein. The vein sealer 1108 a, 1108 b can be, forexample, a bipolar electrode pair, which destroys the tissue part inbetween, but can alternatively also be a clip applying pair of forceps,or some other mechanism. A manipulator 1100 having a vein sealer 1108 a,1108 b as contemplated herein can be useful, for example, in endoscopicsituations, where sealing veins lying in the deeper layers of cavitywalls is necessary. Tissue can be grasped in one move and pulled intothe manipulator, and the vein can be sealed without damaging the otherdeeper layers of the cavity walls.

In addition, as with all other embodiments disclosed herein, themanipulator can include other therapeutic and/or diagnostic toolsbesides a vein sealer.

FIGS. 11C and 11D are side views of the manipulator 1100 in an open andclosed configuration, respectively. An offset can be seen between thegrasping surfaces 1104 a, 1104 b and the vein sealer 1108 a, 1108 b thatavoids physical interference between the grasping surfaces 1104 a, 1104b and the vein sealer 1108 a, 1108 b when the manipulator 1100 isactuated. As shown, the arm 1102 a, 1102 b of the manipulator 1100 has aperpendicular bend so that the manipulator 1100 can approach the targettissue in a direction substantially parallel to the surface of thetarget tissue. The arm of the manipulator can alternatively form anobtuse or acute angle. In this way, sequences requiring several complexmanipulations can be replaced with a single move.

FIG. 12 is a top view of a manipulator 1200 comprising the arms andgrasping surfaces of FIGS. 11A-11D in an open configuration. Themanipulator 1200 comprises a pair of arms 1102 a, 1102 b have aperpendicular bend and are connected together at a pivot 1256 and havinglevers 1252 a, 1252 b for actuation of the arms 1102 a, 1102 b. Proximalends of the levers 1252 a, 1252 b includes finger loops 1250 a, 1250 b.Each of the arms 1102 a, 1102 b is connected with a grasping surface1104 a, 1104 b at a pivot point 1106 a, 1106 b. The grasping surfaces1104 a, 1104 b are actuated to pivot perpendicular to the arms (i.e., inthe plane of the page). A user actuates the manipulator 1200 using thehandles 1252 a, 1252 b. As the arms 1102 a, 1102 b approach each otherthe grasping surfaces 1104 a, 1104 b rotate about a shaft at the pivotpoint 1106 a, 1106 b. Each shaft is aligned along the corresponding arm1102 a, 1102 b so that the grasping surfaces 1104 a, 1104 b rotateperpendicular to the arms 1102 a, 1102 b.

FIG. 13 illustrates a further embodiment of a manipulator 1300 inaccordance with the present invention comprising a single primary arm1330. The arm 1330 includes two location joints 1332, 1334 that allow ahead 1301 of the manipulator 1300 to rotate in one or two axes and abending joint 1336 that allows the head 1301 to bend so that the head isaligned at an angle relative to an axis defined by the arm 1302. Thehead 1301 comprises a pair of smaller arms 1302 a, 1302 b pivotallyconnected with each other at a main pivot point 1303. Each of the arms1302 a, 1302 b is connected with a grasping surface 1304 a, 1304 b at apivot point 1306 a, 1306 b. The manipulator 1300 also includes a veinsealer 1308 a, 1308 b portions of which extend from each arm 1302 a,1302 b. Although in other embodiments, the manipulator can include someother therapeutic and/or diagnostic tool.

The arms 1302 a, 1302 b can be urged together at the pivot point 1303connecting them. The grasping surfaces 1304 a, 1304 b are actuated asthe arms 1302 a, 1302 b are urged together. The grasping surfaces 1304a, 1304 b grasp tissue and pull tissue into the gap between the arms1302 a, 1302 b. As the arms 1302 a, 1302 b come together, the veinsealer 1308 a, 1308 b penetrates the tissue to seal a vein.

FIGS. 14A and 14B illustrate a further embodiment of a manipulator 1400in accordance with the present invention similar to the embodiment ofFIGS. 11A and 11B, but having a vein sealer 1408 a, 1408 b applied totarget tissue to seal a vein. The manipulator 1400 comprises a pair ofarms 1402 a, 1402 b each of which is connected with a grasping surface1404 a, 1404 b at a pivot point 1406 a, 1406 b. Each of the graspingsurfaces 1404 a, 1404 b has a semi-circular shape that curves inwardrelative to the other grasping surface 1404 a, 1404 b. The manipulator1400 also includes the vein sealer 1408 a, 1408 b, but unlike inprevious embodiments, the portions are connected to each arm 1402 a,1402 b by additional, flexible or semi-flexible arms 1440 a, 1440 b thatcan enable the vein sealer 1408 a, 1408 b to function in a semi-closedstate of the manipulator 1400, for example. As with other embodiments,the manipulator can include some other therapeutic and/or diagnostictool.

In FIG. 14A, the manipulator 1400 is open, and the grasping surfaces1404 a, 1404 b are pressed against the tissue 6 at the target site withthe vein 2 arranged between the grasping surfaces 1404 a, 1404 b. As thearms 1402 a, 1402 b are urged together, the grasping surfaces 1404 a,1404 b engage the tissue until the resistance of the tissue between thegrasping surfaces 1404 a, 1404 b overcomes a spring bias so that thegrasping surfaces 1404 a, 1404 b begin to pivot inward. As the graspingsurfaces 1404 a, 1404 b pivot inward, tissue is drawn between the arms1402 a, 1402 b of the manipulator 1400. As the arms 1402 a, 1402 b arefurther urged together and urged closer to muscle 4, the graspingsurfaces 1404 a, 1404 b continue to grasp and pull tissue into the gapbetween the arms 1402 a, 1402 b. As can be seen in FIG. 14B, a contactsurface of the tissue 14 is drawn inward as the head of the manipulator1400 is urged toward the muscle 4 and the vein 2 is arranged between thevein sealer 1408 a, 1408 b portions. The vein sealer 1408 a, 1408 b canthen seals the vein 2. (For example, where the vein sealer includes apair of electrodes, the electrodes can be fired.)

FIG. 15 is an isolated schematic view of a grasping surface 1500 for usewith embodiments of manipulators in accordance with the presentinvention. The grasping surface 1500 extends in a semi-elliptical shapeaway from a pivot point 1506. The distal portion 1520 of the graspingsurface 1500 has a texture that is designed for grasping, while the mainsection 1522 trailing the distal portion 1520 to a proximal end has atexture that is designed for pulling tissue in.

FIGS. 16-18 illustrate additional, detail views of different graspingsurfaces 1604, 1704, 1804 for use with embodiments of manipulators inaccordance with the present invention. Referring to FIG. 16, the rollingsection 1604 has varying width with the distal and proximal ends of therolling section 1604 substantially connected by a back edge 1622 that isnot textured and has a slightly compound angle. The grasping edge 1620of the rolling section 1604 is toothed, with the teeth biased in thedirection towards pulling-in. The bias of the teeth toward pulling-inencourages the grasping surface to grab target tissue when actuating themanipulator to a closed position, while substantially avoiding grabbingtissue when the manipulator is released or actuated to an open position.The rotation shaft 1606 is farther in than the edge of the graspingsurface 1604. Referring to FIG. 17, the grasping surface 1704 resemblespreviously described grasping surfaces in that its width is generallyconsistent along the grasping surface 1704. A grasping edge 1720 of therolling section 1704 is toothed, with the teeth biased in the directiontowards of pulling-in. The rotation shaft 1706 is farther in than theedge of the grasping surface 1700. Referring to FIG. 18, the rollingsection 1804 has varying width and the grasping edge 1820 is shaped in aspiral. The grasping edge 1820 of the rolling section 1804 is toothed,with the teeth biased in the direction towards of pulling-in. Therotation shaft 1806 is even farther in than the edge of the graspingsurface 1804 than the previous grasping surfaces.

FIGS. 19A-19C illustrate a further grasping surface for use withembodiments of manipulators in accordance with the present invention.FIGS. 19A and 19B are partial top views of a grasping surface 1904connected with an arm 1902. The grasping surface 1904 is semi-circularin shape. The grasping surface 1904 is not connected to the arm 1902 bya shaft. Rather, the grasping surface 1904 bends at a pivot point 1906,similar to the embodiment of FIGS. 1A-1I. The distal end of the graspingsurface 1904 is connected to the proximal end of the grasping surface1904 by a brake and plate spring 1924. When the grasping surface 1904 isactuated, the brake and plate spring 1924 resists collapse of thegrasping surface 1904, and helps return the grasping surface 1904 to theunactuated position. The manipulator of FIGS. 19A-19C further comprisesa rigid grasper 1908. As can be seen in the side view of FIG. 19C, therigid grasper 1908 is offset from the grasping surface 1904.

FIGS. 20A and 20B are partial top views illustrating a further graspingsurface 2004 for use with embodiments of manipulators in accordance withthe present invention. The grasping surface 2004 is connected with anarm 2002, and as above bends at a corner 2006, rather than rotating. Thegrasping surface 2004 is semi-parabolic in shape; however there is nobrake and plate spring, and the grasping surface 2004 is bendable sothat the grasping surface 2004 is urged substantially against the arm2002. The grasping surface 2004 pressed to the arm 2002 can even bedeformed, by means of which the diameter of the manipulator can bedecreased during leading, substantially reducing or avoiding the offsetof some embodiments, such as the embodiment shown in FIG. 1.

The geometric shape of the grasping surfaces of FIGS. 19A-20B can be ofseveral types, taking into consideration that the pivot points arefarther and farther from the rotation angle made up by the joint have tobe located farther from the rotation angle in the moment of grasping.

FIGS. 21A-21E illustrate actuation of a pair of the grasping surfaces2104 a, 2104 b of FIG. 21. As the pivot points 2106 a, 2106 b of thegrasping surfaces 2104 a, 2104 b are urged together and the graspingedges 2120 a, 2120 b of the grasping surfaces 2104 a, 2104 b engagetissue, the grasping surfaces 2104 a, 2104 b are pivoted at the pivotpoints 2106 a, 2106 b so that the tissue can be into the manipulator byteeth of the grasping edges 2120 a, 2120 b. The teeth draw in the tissueand advance the tissue into the manipulator 2100 so that the target canbe acted on. For example, the target may be a vein, and the manipulatormay be actuated to seal the vein.

While the previous embodiments have described manipulators havinggrasping surfaces that are usable to grasp and pull tissue toward themanipulator, in still other embodiments manipulators having graspingsurfaces that urge thread and other materials outward and away from themanipulator and outward toward a target.

FIGS. 22A and 22B are partial top views illustrating grasping surfaces2204 for use with embodiments of manipulators in accordance with thepresent invention to urge thread 10, wire, or any target object outwardand away from the manipulator. When the rotations shafts 2206 a, 2206 bof the grasping surfaces are urged together, the grasping surface 2204a, 2204 b are pivoted downward toward the bottom of the page. Thegrasping edge 2220 a, 2220 b has teeth or any other structure or texturepattern that can grasp the thread 10 and urge it downward of the page sothat the thread 10 is advanced away from the manipulator.

FIGS. 23A and 23B are partial end views of an embodiment of amanipulator 2300 in accordance with the present invention for advancinga thread along an axis. The grasping surfaces 2304 a, 2304 b arecircular in shape and grooved. The grasping surfaces 2304 a, 2304 b areconnected with arms 2302 a, 2302 b of the manipulator 2300 and havepivot points 2306 a, 2306 b that are off-center so that the graspingsurfaces 2304 a, 2304 b are cammed in their motion. As shown in FIG.23B, a line guide 2340 feeds a thread or line between the graspingsurfaces 2304 a, 2304 b to prevent binding.

FIG. 23C is a side view of the manipulator 2300 of FIGS. 23A and 23Bshowing the line guide 2340 and a grasping surface 2304 a relative to anarm 2302 a of the manipulator 2300. Referring to FIG. 23D, when the arms2302 a, 2302 b are urged together the grasping surfaces 2306 a, 2306 bare rotated, drawing a line or thread 10 through the line guide 2340 andoutward of the manipulator 2300.

FIGS. 24A-24D illustrate incremental advancement of grasping surfaces2404 a, 2404 b for use with embodiments of manipulators in accordancewith the present invention to advance a target, such as a thread, as themanipulator arms are closed. The pivot points 2406 a, 2406 b in thecircular grasping surfaces can move one way in a circular groove. Whenthe pivot point is stopped it is signed with ‘x’, when it's moving it issigned with a small arrow. Opening and closing the manipulator aresigned with large horizontal arrows above the grasping surfaces.Movement of the target arranged between the grasping surfaces is signedwith a large vertical arrow. When target movement is stopped, it issigned with an ‘X’ below the grasping surfaces. The embodiment of FIGS.24A-24D is similar to that of FIGS. 23A-23D, until the manipulator is ina closed configuration. The manipulator can then be opened with thegrasping surfaces remaining sufficiently closed and motionless such thatthe target is held in position, but the pivot points move in theircircular grooves to the position of FIG. 24A. The manipulator can thenadvance the target again. The grasping surfaces can incrementallyadvance a target or other object while retaining some grasping force toresist retreat of the target. The advancement resembles that when usinga ratchet. The grasping surfaces roll only one way, but do not pull backthe target.

In still other embodiments manipulators having grasping surfaces thatperform other tasks to assist the manipulator are contemplated. Forexample, FIGS. 25A-25E illustrate a pair of further grasping surfaces2504 a, 2504 b for use with embodiments of manipulators in accordancewith the present invention and actuation of the pair of the graspingsurfaces 2504 a, 2504 b. The pivot points 2506 a, 2506 b of the graspingsurfaces 2504 a, 2504 b are arranged proximate to one another in theunactuated position, with the grasping edges 2520 a, 2520 b operating sothat they rotate away from each other. This motion allows themanipulator to be used within a predefined operating space. Suchmanipulators can, for example, be advanced through a tube having a knownor unknown diameter.

FIGS. 26A-26D illustrate a pair of further grasping surfaces 2604 a,2604 b for use with embodiments of manipulators in accordance with thepresent invention arranged within a tube 12 with the back edges of thegrasping surfaces 2604 a, 2604 b against each other. As the graspingsurfaces 2604 a, 2604 b are rotated about a pivot point 2606 a, 2606 bat their respective distal ends, the grasping edges 2620 a, 2620 b pushoutward to expand the diameter of the tube 12. The expanded tube canincrease access to a target site, improve flow through the tube, allowintroduction of tools or other tubes, etc.

FIGS. 27A and 27B illustrate an embodiment of a manipulator 2700 inaccordance with the present invention adapted for pulling in andgrasping tissues with large surfaces and mass and adapted formanipulation in deep layers. The static process of grasping is dividedinto two stages, the first stage including static grapping and thesecond phase including dynamic pulling in and fixing of the tissue. Thegrasping surfaces 2704 a, 2704 b are not actuated by a spring bias, butrather are pivoted by separate mechanics independent, orsemi-independent of arm movement. For example, the grasping surfaces2704 a, 2704 b can be pivoted by cables, complementary arms, etc. Inthis embodiment, the grasping surfaces 2704 a, 2704 b start to rotatewhile the arms 2702 a, 2702 b are closed. The arms then begin to open.The manipulator can be useful, for example, in combination withendoscopes, enabling a large quantity of tissue on a large surface to beprecisely grasped. The manipulator 2700 comprises a pair of arms 2702 a,2702 b each of which is connected with a grasping surface 2704 a, 2704 bat a pivot point 2706 a, 2706 b. The grasping surfaces 2704 a, 2704 bhave a semi-parabolic shape that curves outward with a convexorientation relative to respective arms 2702 a, 2702 b. The arms 2702 a,2702 b of the manipulator 2700, as with all of the embodiments ofmanipulators described herein, can be part of a hand actuated mechanism,for example as a pair of forceps, or alternatively the arms 2702 a, 2702b can extend from a robot that can be controlled by a physician orcontrolled by an automated system.

FIGS. 28A-28E illustrate an embodiment of grasping surfaces 2804 a, 2804b for use as a locomotive device, for example to advance an instrumentor a more complex device such as a robot. As shown, pivot points 2806 a,2806 b of the grasping surfaces 2804 a, 2804 b are connected with adevice (shown schematically as a dotted line). The grasping surfaces2804 a, 2804 b grip and advance along walls 2, 4 with the pivot points2806 a, 2806 b being drawn forward along the walls 2, 4 (upwardsrelative to the page). Likewise, the connected device is drawn forward.The grasping surfaces 2804 a, 2804 b can be useful in myriad differentapplications, such as introducing instruments, cameras, and tools to aninaccessible disaster site, or moving a cleaning robot into a drain.

FIGS. 29A-29C illustrate an embodiment of an endoscope 2900 useable, forexample, in a bowel or a catheter 2 in an artery. As shown in FIGS. 29Aand 29B, the endoscope 2900 is shown being advanced through the catheter2 (upward along the page) through movement of grasping surfaces in theform of plates 2904 a, 2904 b. FIG. 29C illustrates the head 2902 of theendoscope 2900. The moving mechanism is a cable 2990 which splits nearthe end of the head 2902 of the endoscope 2900 to connect to two or more(two as shown) patterned or toothed plates 2904 a, 2904 b. The plates2904 a, 2904 b turn back at pivot points 2906 a, 2906 b at the end ofthe head 2902 of the endoscope 2900 and grip the walls of the catheter2. Advancing the cable 2990, the plates 2904 a, 2904 b moves backward,advancing the endoscope 2900. This advancement can be limited to alength of the plates 2904 a, 2904 b and/or cable 2990; however, theadvancement can assist in moving the endoscope 2900 when the endoscope2900 cannot be advanced by pushing the endoscope 2900 along the catheter2.

FIG. 30 is a top view a still further embodiment of a head 3000 for usewith manipulators in accordance with the present invention. The arms3002 a, 3002 b resemble a clip, connecting at a proximal end. Apatterned plate 3004 having a “V” shape that acts as grasping surfacesis connected with a distal end of the arms 3002 a, 3002 b. As the distalends of the arms 3002 a, 3002 b are urged together, the graspingsurfaces of the plate 3004 grab, pulls in, and fixes a target betweenthe arms 3002 a, 3002 b.

In certain embodiments described herein, application fields for theinvention include, but are not limited to, grasping of tissues inlocations difficult to access and movement within and manipulation oftubes and other walled structures. However, upon reflecting on theteachings contained herein, one of ordinary skill in the art willappreciate the myriad different applications and variations ofactuatable grasping surfaces, all of which are intended to fall withinthe scope of the invention.

The previous description of the preferred embodiments is provided toenable any person skilled in the art to make or use the embodiments ofthe present invention. While the invention has been particularly shownand described with reference to preferred embodiments thereof, it willbe understood by those skilled in the art that various changes in formand details may be made therein without departing from the spirit andscope of the invention.

1-20. (canceled)
 21. A manipulator adapted to grasp and draw tissuecomprising: a first arm having a distal end and a proximal end; a secondarm having a distal end and a proximal end; wherein the distal ends ofthe first and second arm are separated by a distance; a first graspingsurface connected to and extending from the distal end of the first armat a first pivot point; a second grasping surface connected to andextending from the distal end of the second arm at a second pivot point;wherein the first grasping surface and the second grasping surface areconnected together and are biased toward each other; wherein the firstarm and second arm are actuatable so that the first grasping surface andthe second grasping surface pivot at the respective first and secondpivot points such that the distance between the distal ends of the firstand second arms is reduced; and wherein when the manipulator is actuatedto reduce the distance of the distal ends of the first and the secondarms, tissue is configured to be drawn toward the proximal ends of thefirst and the second arms.
 22. The manipulator of claim 21, wherein thefirst and second grasping surfaces are connected together to form a “V”shape.
 23. The manipulator of claim 21, wherein the first arm and thesecond arm are hingedly connected at respective proximal ends.
 24. Themanipulator of claim 21, wherein the first arm and the second arm aremanually actuatable by a user.
 25. The manipulator of claim 21, whereinthe first arm and the second arm are remotely actuatable. 26.manipulator of claim 21, further comprising: a therapeutic or diagnosticdevice having a first portion connected with the first arm and a secondportion connected with the second arm; wherein when the first graspingsurface and the second grasping surface reach a threshold actuation, thetherapeutic or diagnostic device is operatable.
 27. The manipulator ofclaim 21, wherein the therapeutic or diagnostic device is a vein sealerand the first portion is a first vein sealer portion and the secondportion is a second vein sealer portion; and wherein when the firstgrasping surface and the second grasping surface reach a thresholdactuation, the first vein sealer portion and the second vein sealerportion are operatable to seal a vein held therebetween.
 28. Themanipulator of claim 27, wherein the first and second vein sealerportions are a bipolar electrode pair.
 29. The manipulator of claim 27,wherein the first and second vein sealer portions are a clip applyingpair of forceps.
 30. The manipulator of claim 21, wherein the first andsecond grasping surfaces each are curved.
 31. The manipulator of claim21, further comprising: a first rigid grasper connected with the firstarm; a second rigid grasper connected with the second arm; wherein whenthe first grasping surface and the second grasping surface reach athreshold actuation, the tissue drawn toward the manipulator is firmlyheld between the first rigid grasper and the second rigid grasper. 32.The manipulator of claim 21, further comprising: a first vein sealerportion connected with the first arm; a second vein sealer portionconnected with the second arm; wherein when the first grasping surfaceand the second grasping surface reach a threshold actuation, the firstvein sealer portion and the second vein sealer portion are operatable toseal a vein held therebetween.
 33. A manipulator adapted to grasp anddraw tissue comprising: a first arm having a distal end and a proximalend; a second arm having a distal end and a proximal end; wherein thedistal ends of the first and second arm are separated by a distance; afirst grasping surface connected to and extending from the distal end ofthe first arm at a first pivot point; a second grasping surfaceconnected to and extending from the distal end of the second arm at asecond pivot point; wherein the first grasping surface and the secondgrasping surface are connected together and are biased toward eachother; wherein the first arm and second arm are actuatable so that thefirst grasping surface and the second grasping surface pivot at therespective first and second pivot points such that the distance betweenthe distal ends of the first and second arms is reduced; wherein thefirst and second grasping surfaces form a “V” shape; wherein the firstand second pivot points and the first grasping surface and the secondgrasping surface are offset from a plane defined by the first arm andthe second arm in order for the first and second grasping surfaces toavoid interference with said first and second arms; and wherein when themanipulator is actuated to reduce the distance of the distal ends of thefirst and the second arms, tissue is configured to be drawn toward theproximal ends of the first and the second arms.
 34. The manipulator ofclaim 33, wherein the first and second grasping surfaces are curved. 35.The manipulator of claim 33, wherein the first arm and the second armare hingedly connected at respective proximal ends.
 36. The manipulatorof claim 33, wherein the first arm and the second arm are manuallyactuatable by a user.
 37. The manipulator of claim 33, wherein the firstarm and the second arm are remotely actuatable.
 38. A manipulatoradapted to grasp and draw tissue comprising: a first arm having a distalend and a proximal end; a second arm having a distal end and a proximalend; wherein the distal ends of the first and second arm are separatedby a distance; a first grasping surface connected to and extending fromthe distal end of the first arm at a first pivot point; a secondgrasping surface connected to and extending from the distal end of thesecond arm at a second pivot point; wherein the first grasping surfaceand the second grasping surface are curved and connected together andare biased toward each other by a respective first and second springforce; wherein the first arm and second arm are actuatable to overcomethe first and second spring forces of the respective first graspingsurface and the second grasping surface, the first grasping surface andthe second grasping surface pivot at the respective first and secondpivot points such that the distance between the distal ends of the firstand second arms is reduced; wherein the first and second graspingsurfaces form a “V” shape; wherein the first and second pivot points andthe first grasping surface and the second grasping surface are offsetfrom a plane defined by the first arm and the second arm in order forthe first and second grasping surfaces to avoid interference with saidfirst and second arms; and wherein when the manipulator is actuated toreduce the distance of the distal ends of the first and the second arms,tissue is configured to be drawn toward the proximal ends of the firstand the second arms.
 39. The manipulator of claim 38, wherein the firstarm and the second arm are hingedly connected at respective proximalends.
 40. The manipulator of claim 38, wherein the first arm and thesecond arm are at least one of manually actuatable and remotelyactuatable by a user.